Schriver Michael, Cubaka Vincent K, Nyirazinyoye Laetitia, Itangishaka Sylvere, Kallestrup Per
Centre for Global Health, Department of Public Health, Aarhus University, Denmark; Aarhus University Hospital.
Afr J Prim Health Care Fam Med. 2017 Nov 1;9(1):e1-e11. doi: 10.4102/phcfm.v9i1.1508.
External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa.
To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda.
We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5).
Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors.
While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems.
External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers' experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels.
卢旺达基层医疗设施的外部监督是监督人员与医疗服务提供者之间的一种互动。在卢旺达，他们之间的关系尚未得到充分研究，在非洲也很少见。
探讨卢旺达公共基层医疗设施中医疗服务提供者与其外部监督人员之间关系的感知特征和影响。
我们与基层医疗服务提供者进行了三次焦点小组讨论（n = 16），与外部监督人员进行了三次（n = 15），并进行了一次混合讨论（n = 5）。
在主持人参与度较低的情况下组织焦点小组讨论。通过主题提取研究结果，并与参与和未参与的医疗服务提供者及监督人员进行讨论。
虽然外部监督除了具有管理目的外，还旨在成为激励和专业发展的源泉，但在卢旺达基层医疗服务提供者中，它似乎与过度的评估焦虑有关。监督人员主要将此与基于绩效的融资中不可避免的评估联系起来，而医疗服务提供者还将其与沟通问题联系起来。
外部监督似乎是由系统的绩效评估驱动的，这可能会导致监督权力关系严重不对称，并对探索医疗服务提供者遇到的工作问题的意图构成挑战。存在这种情况可能损害医疗服务提供者积极性的风险，因此需要仔细关注影响监督关系的因素。最需要监督以提高绩效的医疗服务提供者最不可能从中受益，这是一个两难境地。本研究表明需要以医疗服务提供者为导向的支持性监督，包括对有绩效困难的医疗服务提供者给予建设性关注、建立有效的关系和沟通、进行客观勤勉的评估以及建立双向反馈渠道。
